Acute haematogenous osteomyelitis of femur in a neonate with ‘bone within bone’ appearance: a case report.

Acute osteomyelitis in infants, which was known for high mortality and morbidity in the pre-antibiotic era can be managed conservatively by intravenous antibiotics and supportive therapy if the condition is detected and treatment started early in the course of the disease. Infantile osteomyelitis is separate entity from the one seen in older children in terms of vascular anatomy, pathogenesis, radiological changes and natural history. We present a neonate with acute haematogenous osteomyelitis of femur with preceding respiratory tract infection that was managed conservatively without surgical intervention despite severe radiographic changes. The child recovered without any residual deformity and final radiographs did not show any trace of the disease though early radiographs had exuberant involucrum formation and sequestration of entire diaphysis giving it a “bone within bone” appearance. Infants have excellent capacity of re-sorption of sequestrum and remodelling of involucrum such that no trace of disease is left in the adulthood.

Aspectos radiográficos de periostite ossificante em metatarso de vaca Holandesa / Radiografic aspects of ossifying periostitis in metatarsus of Holstein cow

Periostite ossificante é uma neoformação óssea inflamatória extensa, frequentemente oriunda de infecção de tecidos moles adjacentes ao osso afetado, sendo mais proeminente nos bovinos, especialmente em animais jovens. Neste trabalho, é descrito um caso de periostite ossificante no osso metatársico III direito de uma vaca Holandesa após trauma. O diagnóstico foi realizado com base nos achados clínicos e radiográficos e confirmado cirurgicamente.

Ossifying periostitis is an extensive inflamatory new bone formation frequently extensive from soft tissue infection next to these bones. It is more observed in young bovines. A case of pos traumatic ossifying periostitis in the right metatarsus of a Holstein cow is described. The diagnosis was made based on clinical and radiographic findings and confirmed cirurgically.

Study of Periosteal Reaction in Normal Infants / 대한정형외과학회잡지

The incidental observation of periosteal new bone formation on long bones is common in pediatric radiology without any symptoms in extremities : for example, the humeri on chest examination and the femora on abdominal roentgenograms. The purposes of the author is to report the results of a roentgenologic study of the long bones in 100 normal infants and 100 chilren between 1 and 2 years old who had no symptoms refereble to the skeleton to determine the incidence, roentgen characteristics, pathogenesis and significance of this type of periosteal new bone. The results obtained were as follows : 1. Periosteal new bone occured in 28% in normal infants group but did not occured in children group between 1 and 2 years. 2. The site in order of decreasing frequency were femur, tibia, and humerus. 3. Periosteal new bone is always on the diaphysis and usually extended onto the metaphysis to a variable extent, but it has not been observed to reach the end of metaphysis. 4. It seems most logical that the periosteal new bone found in these infants is simply a roentgen manifestation of normal periosteal bone growth in the period of greatest activity. 5. It is not an indication for treatment unless a definite relationship with a specific disease is proven.